Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-30 (of 30 Records) |
Query Trace: Dutta V [original query] |
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Field effectiveness of a typhoid conjugate vaccine: The 2018 Navi Mumbai Pediatric TCV Campaign
Date K , LeBoa C , Hoffman SA , Haldar P , Harvey P , An Q , Zhang C , Yewale VN , Daruwalla S , Dharmapalan D , Gavhane J , Joshi S , Rai R , Rathod V , Shetty K , Warrier DS , Yadav S , Shimpi R , Jayaprasad N , Horng L , Fagerli K , Borhade P , Chakraborty D , Katkar A , Kunwar A , Andrews JR , Bahl S , Bhatnagar P , Dutta S , Luby SP . Am J Trop Med Hyg 2024 Typbar-TCV®, a typhoid conjugate vaccine (TCV), was prequalified by the World Health Organization in 2017. We evaluated its effectiveness in a mass vaccination program targeting children 9 months to 14 years in Navi Mumbai, India, from September 2018 to July 2020. We compared laboratory-confirmed typhoid cases from six clinical sites with age-matched community controls. Of 38 cases, three (8.6%) received TCV through the campaign, compared with 53 (37%) of 140 controls. The adjusted odds ratio of typhoid fever among vaccinated children was 0.16 (95% CI: 0.05-0.55), equivalent to a vaccine effectiveness of 83.7% (95% CI: 45.0-95.3). Vaccine effectiveness of Typbar-TCV in this large public sector vaccine introduction was similar to prior randomized controlled trials, providing reassurance to policymakers that TCV effectiveness is robust in a large-scale implementation. |
Global diversity and antimicrobial resistance of typhoid fever pathogens: Insights from a meta-analysis of 13,000 Salmonella Typhi genomes
Carey ME , Dyson ZA , Ingle DJ , Amir A , Aworh MK , Chattaway MA , Chew KL , Crump JA , Feasey NA , Howden BP , Keddy KH , Maes M , Parry CM , Van Puyvelde S , Webb HE , Afolayan AO , Alexander AP , Anandan S , Andrews JR , Ashton PM , Basnyat B , Bavdekar A , Bogoch II , Clemens JD , da Silva KE , De A , de Ligt J , Diaz Guevara PL , Dolecek C , Dutta S , Ehlers MM , Francois Watkins L , Garrett DO , Godbole G , Gordon MA , Greenhill AR , Griffin C , Gupta M , Hendriksen RS , Heyderman RS , Hooda Y , Hormazabal JC , Ikhimiukor OO , Iqbal J , Jacob JJ , Jenkins C , Jinka DR , John J , Kang G , Kanteh A , Kapil A , Karkey A , Kariuki S , Kingsley RA , Koshy RM , Lauer AC , Levine MM , Lingegowda RK , Luby SP , Mackenzie GA , Mashe T , Msefula C , Mutreja A , Nagaraj G , Nagaraj S , Nair S , Naseri TK , Nimarota-Brown S , Njamkepo E , Okeke IN , Perumal SPB , Pollard AJ , Pragasam AK , Qadri F , Qamar FN , Rahman SIA , Rambocus SD , Rasko DA , Ray P , Robins-Browne R , Rongsen-Chandola T , Rutanga JP , Saha SK , Saha S , Saigal K , Sajib MSI , Seidman JC , Shakya J , Shamanna V , Shastri J , Shrestha R , Sia S , Sikorski MJ , Singh A , Smith AM , Tagg KA , Tamrakar D , Tanmoy AM , Thomas M , Thomas MS , Thomsen R , Thomson NR , Tupua S , Vaidya K , Valcanis M , Veeraraghavan B , Weill FX , Wright J , Dougan G , Argimón S , Keane JA , Aanensen DM , Baker S , Holt KE . Elife 2023 12 BACKGROUND: The Global Typhoid Genomics Consortium was established to bring together the typhoid research community to aggregate and analyse Salmonella enterica serovar Typhi (Typhi) genomic data to inform public health action. This analysis, which marks 22 years since the publication of the first Typhi genome, represents the largest Typhi genome sequence collection to date (n=13,000). METHODS: This is a meta-analysis of global genotype and antimicrobial resistance (AMR) determinants extracted from previously sequenced genome data and analysed using consistent methods implemented in open analysis platforms GenoTyphi and Pathogenwatch. RESULTS: Compared with previous global snapshots, the data highlight that genotype 4.3.1 (H58) has not spread beyond Asia and Eastern/Southern Africa; in other regions, distinct genotypes dominate and have independently evolved AMR. Data gaps remain in many parts of the world, and we show the potential of travel-associated sequences to provide informal 'sentinel' surveillance for such locations. The data indicate that ciprofloxacin non-susceptibility (>1 resistance determinant) is widespread across geographies and genotypes, with high-level ciprofloxacin resistance (≥3 determinants) reaching 20% prevalence in South Asia. Extensively drug-resistant (XDR) typhoid has become dominant in Pakistan (70% in 2020) but has not yet become established elsewhere. Ceftriaxone resistance has emerged in eight non-XDR genotypes, including a ciprofloxacin-resistant lineage (4.3.1.2.1) in India. Azithromycin resistance mutations were detected at low prevalence in South Asia, including in two common ciprofloxacin-resistant genotypes. CONCLUSIONS: The consortium's aim is to encourage continued data sharing and collaboration to monitor the emergence and global spread of AMR Typhi, and to inform decision-making around the introduction of typhoid conjugate vaccines (TCVs) and other prevention and control strategies. FUNDING: No specific funding was awarded for this meta-analysis. Coordinators were supported by fellowships from the European Union (ZAD received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 845681), the Wellcome Trust (SB, Wellcome Trust Senior Fellowship), and the National Health and Medical Research Council (DJI is supported by an NHMRC Investigator Grant [GNT1195210]). | Salmonella Typhi (Typhi) is a type of bacteria that causes typhoid fever. More than 110,000 people die from this disease each year, predominantly in areas of sub-Saharan Africa and South Asia with limited access to safe water and sanitation. Clinicians use antibiotics to treat typhoid fever, but scientists worry that the spread of antimicrobial-resistant Typhi could render the drugs ineffective, leading to increased typhoid fever mortality. The World Health Organization has prequalified two vaccines that are highly effective in preventing typhoid fever and may also help limit the emergence and spread of resistant Typhi. In low resource settings, public health officials must make difficult trade-off decisions about which new vaccines to introduce into already crowded immunization schedules. Understanding the local burden of antimicrobial-resistant Typhi and how it is spreading could help inform their actions. The Global Typhoid Genomics Consortium analyzed 13,000 Typhi genomes from 110 countries to provide a global overview of genetic diversity and antimicrobial-resistant patterns. The analysis showed great genetic diversity of the different strains between countries and regions. For example, the H58 Typhi variant, which is often drug-resistant, has spread rapidly through Asia and Eastern and Southern Africa, but is less common in other regions. However, distinct strains of other drug-resistant Typhi have emerged in other parts of the world. Resistance to the antibiotic ciprofloxacin was widespread and accounted for over 85% of cases in South Africa. Around 70% of Typhi from Pakistan were extensively drug-resistant in 2020, but these hard-to-treat variants have not yet become established elsewhere. Variants that are resistant to both ciprofloxacin and ceftriaxone have been identified, and azithromycin resistance has also appeared in several different variants across South Asia. The Consortium’s analyses provide valuable insights into the global distribution and transmission patterns of drug-resistant Typhi. Limited genetic data were available fromseveral regions, but data from travel-associated cases helped fill some regional gaps. These findings may help serve as a starting point for collective sharing and analyses of genetic data to inform local public health action. Funders need to provide ongoing supportto help fill global surveillance data gaps. | eng |
Population structure and antimicrobial resistance patterns of Salmonella Typhi and Paratyphi A amid a phased municipal vaccination campaign in Navi Mumbai, India
da Silva KE , Date K , Hirani N , LeBoa C , Jayaprasad N , Borhade P , Warren J , Shimpi R , Hoffman SA , Mikoleit M , Bhatnagar P , Cao Y , Haldar P , Harvey P , Zhang C , Daruwalla S , Dharmapalan D , Gavhane J , Joshi S , Rai R , Rathod V , Shetty K , Warrier DS , Yadav S , Chakraborty D , Bahl S , Katkar A , Kunwar A , Yewale V , Dutta S , Luby SP , Andrews JR . mBio 2023 14 (4) e0117923 We performed whole-genome sequencing of 174 Salmonella Typhi and 54 Salmonella Paratyphi A isolates collected through prospective surveillance in the context of a phased typhoid conjugate vaccine introduction in Navi Mumbai, India. We investigate the temporal and geographical patterns of emergence and spread of antimicrobial resistance. We evaluated the relationship between the spatial distance between households and genetic clustering of isolates. Most isolates were non-susceptible to fluoroquinolones, with nearly 20% containing ≥3 quinolone resistance-determining region mutations. Two H58 isolates carried an IncX3 plasmid containing bla(SHV-12), associated with ceftriaxone resistance, suggesting that the ceftriaxone-resistant isolates from India independently evolved on multiple occasions. Among S. Typhi, we identified two main clades circulating (2.2 and 4.3.1 [H58]); 2.2 isolates were closely related following a single introduction around 2007, whereas H58 isolates had been introduced multiple times to the city. Increasing geographic distance between isolates was strongly associated with genetic clustering (odds ratio [OR] = 0.72 per km; 95% credible interval [CrI]: 0.66-0.79). This effect was seen for distances up to 5 km (OR = 0.65 per km; 95% CrI: 0.59-0.73) but not seen for distances beyond 5 km (OR = 1.02 per km; 95% CrI: 0.83-1.26). There was a non-significant reduction in odds of clustering for pairs of isolates in vaccination communities compared with non-vaccination communities or mixed pairs compared with non-vaccination communities. Our findings indicate that S. Typhi was repeatedly introduced into Navi Mumbai and then spread locally, with strong evidence of spatial genetic clustering. In addition to vaccination, local interventions to improve water and sanitation will be critical to interrupt transmission. IMPORTANCE Enteric fever remains a major public health concern in many low- and middle-income countries, as antimicrobial resistance (AMR) continues to emerge. Geographical patterns of typhoidal Salmonella spread, critical to monitoring AMR and planning interventions, are poorly understood. We performed whole-genome sequencing of S. Typhi and S. Paratyphi A isolates collected in Navi Mumbai, India before and after a typhoid conjugate vaccine introduction. From timed phylogenies, we found two dominant circulating lineages of S. Typhi in Navi Mumbai-lineage 2.2, which expanded following a single introduction a decade prior, and 4.3.1 (H58), which had been introduced repeatedly from other parts of India, frequently containing "triple mutations" conferring high-level ciprofloxacin resistance. Using Bayesian hierarchical statistical models, we found that spatial distance between cases was strongly associated with genetic clustering at a fine scale (<5 km). Together, these findings suggest that antimicrobial-resistant S. Typhi frequently flows between cities and then spreads highly locally, which may inform surveillance and prevention strategies. |
Automated classification of the phases relevant to work-related musculoskeletal injury risks in residential roof shingle installation operations using machine learning
Dutta A , Breloff SP , Mahmud D , Dai F , Sinsel EW , Warren CM , Wu JZ . Buildings 2023 13 (6) Awkward kneeling in sloped shingle installation operations exposes roofers to knee musculoskeletal disorder (MSD) risks. To address the varying levels of risk associated with different phases of shingle installation, this research investigated utilizing machine learning to automatically classify seven distinct phases in a typical shingle installation task. The classification process relied on analyzing knee kinematics data and roof slope information. Nine participants were recruited and performed simulated shingle installation tasks while kneeling on a sloped wooden platform. The knee kinematics data were collected using an optical motion capture system. Three supervised machine learning classification methods (i.e., k-nearest neighbors (KNNs), decision tree (DT), and random forest (RF)) were selected for evaluation. The KNN classifier provided the best performance for overall accuracy. The results substantiated the feasibility of applying machine learning in classifying shingle installation phases from workers’ knee joint rotation and roof slope angles, which may help facilitate method and tool development for automated knee MSD risk surveillance and assessment among roofers. © 2023 by the authors. |
Population structure and antimicrobial resistance patterns of Salmonella Typhi and Paratyphi A amid a phased municipal vaccination campaign in Navi Mumbai, India (preprint)
Da Silva KE , Date K , Hirani N , LeBoa C , Jayaprasad N , Borhade P , Warren J , Shimpi R , Hoffman SASS , Mikoleit M , Bhatnagar P , Cao Y , Dutta S , Luby SP , Andrews JR . medRxiv 2023 28 We performed whole genome sequencing of 174 Salmonella Typhi and 54 Salmonella Paratyphi A isolates collected through prospective and retrospective surveillance in the context of a phased typhoid conjugate vaccine introduction in Navi Mumbai, India. We investigate the temporal and geographical patters of emergence and spread of antimicrobial resistance. Additionally, we evaluated the relationship between the spatial distance between households and genetic clustering of isolates using hierarchical Bayesian models. Most isolates were non-susceptible to fluoroquinolones, with nearly 20% containing >=3 mutations in the quinolone resistance determining region, conferring high-level resistance. Two H58 isolates carried an IncX3 resistance plasmid containing bla<inf>SHV-12</inf>, associated with ceftriaxone resistance, suggesting that the ceftriaxone-resistant S. Typhi isolates from India have evolved independently on multiple occasions. Among S. Typhi isolates, we identified two main clades circulating in Navi Mumbai (2.2 and 4.3.1 [H58]); 2.2 isolates were closely related following a single introduction around 2007, whereas H58 isolates had been introduced multiple times to the city. Increasing geographic distance between isolates was strongly associated with genetic clustering (OR 0.72 per km; 95% CrI: 0.66-0.79). This effect was seen for distances up to 5 km (OR 0.65 per km; 95% CrI: 0.59-0.73) but was not seen for distances beyond 5 km (OR 1.02 per km; 95% CrI: 0.83-1.26). Our findings indicate that S. Typhi was repeatedly introduced into Navi Mumbai and then spread locally, with strong evidence of spatial-genetic clustering. In addition to vaccination, local interventions to improve water and sanitation will be critical to interrupt transmission. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license. |
Programmatic Effectiveness of a Pediatric Typhoid Conjugate Vaccine Campaign in Navi Mumbai, India (preprint)
Hoffman SA , LeBoa C , Date K , Haldar P , Harvey P , Shimpi R , An Q , Zhang C , Jayaprasad N , Horng L , Fagerli K , Borhade P , Chakraborty D , Bahl S , Katkar A , Kunwar A , Yewale V , Andrews JR , Bhatnagar P , Dutta S , Luby SP . medRxiv 2022 27 Background: The WHO recommends vaccines for prevention and control of typhoid fever, especially where antimicrobial-resistant typhoid circulates. In 2018 the Navi Mumbai Municipal Corporation (NMMC), implemented a TCV campaign. The campaign targeted all children aged 9-months through 14-years within NMMC boundaries (~320,000 children) over 2 vaccination phases. The phase 1 campaign occurred from July 14-August 25, 2018 (71% coverage, ~113,420 children). We evaluated the campaign's programmatic effectiveness in reducing typhoid cases at the community level. Method(s): We established prospective, blood culture-based surveillance at 6 hospitals in Navi Mumbai, offering blood cultures to children presenting with fever for at least 3 days. We employed a cluster-randomized test-negative design to estimate the effectiveness of the vaccination campaign on pediatric typhoid cases. We matched culture-confirmed typhoid cases with up to 3 culture-negative controls by age and date of blood culture and assessed community vaccine campaign phase as an exposure using conditional logistic regression. Result(s): Between September 1, 2018-March 31, 2021, we identified 81 typhoid cases and matched these with 238 controls. Cases were 0.44 times as likely to live in vaccine campaign communities (campaign effectiveness, 56%, 95%CI: 25%-74%, p=0.002). Cases >= 5-years-old were 0.37 times as likely (95% CI: 0.19-0.70; p-value = 0.002) and cases during the first year of surveillance were 0.30 times as likely (95% CI: 0.14-0.64; p-value = 0.002) to live in vaccine campaign communities. Conclusion(s): Our findings support the use of TCV mass vaccination campaigns as effective population-based tools to combat typhoid fever. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license. |
Programmatic effectiveness of a pediatric typhoid conjugate vaccine campaign in Navi Mumbai, India
Hoffman SA , LeBoa C , Date K , Haldar P , Harvey P , Shimpi R , An Q , Zhang C , Jayaprasad N , Horng L , Fagerli K , Borhade P , Chakraborty D , Bahl S , Katkar A , Kunwar A , Yewale V , Andrews JR , Bhatnagar P , Dutta S , Luby SP . Clin Infect Dis 2023 BACKGROUND: The WHO recommends vaccines for prevention and control of typhoid fever, especially where antimicrobial-resistant typhoid circulates. In 2018 the Navi Mumbai Municipal Corporation (NMMC), implemented a TCV campaign. The campaign targeted all children aged 9-months through 14-years within NMMC boundaries (∼320,000 children) over 2 vaccination phases. The phase 1 campaign occurred from July 14-August 25, 2018 (71% coverage, ∼113,420 children). We evaluated the phase 1 campaign's programmatic effectiveness in reducing typhoid cases at the community level. METHODS: We established prospective, blood culture-based surveillance at 6 hospitals in Navi Mumbai, offering blood cultures to children presenting with fever ≥ 3 days. We employed a cluster-randomized (by administrative boundary) test-negative design to estimate the effectiveness of the vaccination campaign on pediatric typhoid cases. We matched test-positive, culture-confirmed typhoid cases with up to 3 test-negative, culture-negative controls by age and date of blood culture and assessed community vaccine campaign phase as an exposure using conditional logistic regression. RESULTS: Between September 1, 2018-March 31, 2021, we identified 81 typhoid cases and matched these with 238 controls. Cases were 0.44 times as likely to live in vaccine campaign communities (programmatic effectiveness, 56%, 95%CI: 25%-74%, p=0.002). Cases ≥ 5-years-old were 0.37 times as likely (95% CI: 0.19-0.70; p-value = 0.002) and cases during the first year of surveillance were 0.30 times as likely (95% CI: 0.14-0.64; p-value = 0.002) to live in vaccine campaign communities. CONCLUSIONS: Our findings support the use of TCV mass vaccination campaigns as effective population-based tools to combat typhoid fever. |
Application of Data Fusion via Canonical Polyadic Decomposition in Risk Assessment of Musculoskeletal Disorders in Construction: Procedure and Stability Evaluation
Dutta A , Breloff SP , Dai F , Sinsel EW , Warren CM , Carey RE , Wu JZ . J Constr Eng Manage 2021 147 (8) Missing data is a common problem in data collection for work-related musculoskeletal disorder (WMSD) risk-assessment studies. It can cause incompleteness of risk indicators, leading to erroneous conclusion on potential risk factors. Previous studies suggested that data fusion is a potential way to solve this issue. This research evaluated the numerical stability of a data fusion technique that applies canonical polyadic decomposition (CPD) for WMSD risk assessment in construction. Two knee WMSD risk-related data sets - three-dimensional (3D) knee rotation (kinematics) and electromyography (EMG) of five knee postural muscles - collected from previous studies were fused for the evaluation. By comparing the consistency performance with and without data fusion, it revealed that for all low to high proportion of missing data (10%-70%) from both kinematics and EMG data sets, the WMSD risk assessment using fused data sets outperformed using unfused kinematics data sets. For large proportions of missing data (>50%) from both kinematics and EMG data sets, better performance was observed by using fused data sets in comparison with unfused EMG data sets. These findings suggest that data fusion using CPD generates a more reliable risk assessment compared with data sets with missing values and therefore is an effective approach for remedying missing data in WMSD risk evaluation. © 2021 American Society of Civil Engineers. |
Cholera outbreak associated with contaminated water sources in paddy fields, Mandla District, Madhya Pradesh, India
Dutta BP , Kumar N , Meshram KC , Yadav R , Sodha SV , Gupta S . Indian J Public Health 2021 65 S46-s50 BACKGROUND: Mandla District in Madhya Pradesh, India, reported a suspected cholera outbreak from Ghughri subdistrict on August 18, 2016. OBJECTIVE: We investigated to determine risk factors and recommend control and prevention measures. METHODS: We defined a case as >3 loose stools in 24 h in a Ghughri resident between July 20 and August 19, 2016. We identified cases by passive surveillance in health facilities and by a house-to-house survey in 28 highly affected villages. We conducted a 1:2 unmatched case-control study, collected stool samples for culture, and tested water sources for fecal contamination. RESULTS: We identified 628 cases (61% female) from 96 villages; the median age was 27 years (range: 1 month-76 years). Illnesses began 7 days after rainfall with 259 (41%) hospitalizations and 14 (2%) deaths in people from remote villages who died before reaching a health facility; 12 (86%) worked in paddy fields. Illness was associated with drinking well water within paddy fields (odds ratio [OR] = 4.0, 95% confidence interval [CI] = 1.4-8.0) and not washing hands with soap after defecation (OR = 6.1, CI = 1.7-21). Of 34 stool cultures, 11 (34%) tested positive for Vibrio cholerae O1 Ogawa. We observed open defecation in affected villages around paddy fields. Of 16 tested water sources in paddy fields, eight (50%) were protected, but 100% had fecal contamination. CONCLUSION: We recommended education regarding pit latrine sanitation and safe water, especially in paddy fields, provision of oral rehydration solution in remote villages, and chlorine tablets for point-of-use treatment of drinking water. |
Evaluation of vaccine safety after the first public sector introduction of typhoid conjugate vaccine - Navi Mumbai, India, 2018
Longley AT , Date K , Luby SP , Bhatnagar P , Bentsi-Enchill AD , Goyal V , Shimpi R , Katkar A , Yewale V , Jayaprasad N , Horng L , Kunwar A , Harvey P , Haldar P , Dutta S , Gidudu J . Clin Infect Dis 2021 73 (4) e927-e933 BACKGROUND: In December 2017, the World Health Organization (WHO) prequalified the first typhoid conjugate vaccine (TCV) (Typbar-TCV). While no safety concerns were identified in pre- and post-licensure studies, WHO's Global Advisory Committee on Vaccine Safety recommended robust safety evaluation with large-scale TCV introductions. During July-August 2018, the Navi Mumbai Municipal Corporation (NMMC) launched the world's first public sector TCV introduction. Per administrative reports, 113,420 children 9 months-14 years old received TCV. METHODS: We evaluated adverse events following immunization (AEFI) using passive and active surveillance via 1) reports from the passive NMMC AEFI surveillance system, 2) telephone interviews with 5% of caregivers of vaccine recipients 48 hours and 7 days post-vaccination, and 3) chart abstraction for adverse events of special interest (AESI) among patients admitted to 5 hospitals using the Brighton Collaboration criteria followed by ascertainment of vaccination status. RESULTS: We identified 222/113,420 (0.2%) AEFI through the NMMC AEFI surveillance system: 211 (0.19%) minor, 2 (0.002%) severe, and 9 (0.008%) serious. At 48 hours post-vaccination, 1,852/5,605 (33%) caregivers reported one or more AEFI, including injection site pain (n=1,452, 26%), swelling (n=419, 7.5%), and fever (n=416, 7.4%). Of the 4,728 interviews completed at 7 days post-vaccination, the most reported AEFI included fever (n=200, 4%), pain (n=52, 1%), and headache (n=42, 1%). Among 525 hospitalized children diagnosed with an AESI, 60 were vaccinated; no AESI were causally associated with TCV. CONCLUSIONS: No unexpected safety signals were identified with TCV introduction. This provides further reassurance for the large-scale use of Typbar-TCV among children 9 months-14 years old. |
A heterogenous swine show circuit drives zoonotic transmission of influenza A viruses in the United States.
Nelson MI , Perofsky A , McBride DS , Rambo-Martin BL , Wilson MM , Barnes JR , van Bakel H , Khan Z , Dutta J , Nolting JM , Bowman AS . J Virol 2020 94 (24) Influenza pandemics are associated with severe morbidity, mortality, and social and economic disruption. Every summer in the United States, youths attending agricultural fairs are exposed to genetically diverse influenza A viruses (IAVs) circulating in exhibition swine, resulting in over 450 lab-confirmed zoonotic infections since 2010. Exhibition swine represent a small, defined population (∼1.5% of the US herd), presenting a realistic opportunity to mitigate a pandemic threat by reducing IAV transmission in the animals themselves. Through intensive surveillance and genetic sequencing of IAVs in exhibition swine in six US states in 2018 (n = 212), we characterize how a heterogenous circuit of swine shows, comprised of fairs with different sizes and geographic coverage, facilitates IAV transmission among exhibition swine and into humans. Specifically, we identify the role of an early-season national show in the propagation and spatial dissemination of a specific virus (H1δ-2) that becomes dominant among exhibition swine and is associated with the majority of zoonotic infections in 2018. These findings suggest that a highly targeted mitigation strategy, such as postponing swine shows for 1-2 weeks following the early-season national show, could potentially reduce IAV transmission in exhibition swine and spillover into humans, and merits further study.IMPORTANCE The varying influenza A virus (IAV) exposure and infection status of individual swine facilitates introduction, transmission, and dissemination of diverse IAVs. Since agricultural fairs bring people into intimate contact with swine is provides a unique interface for zoonotic transmission of IAV. Understanding the transmission dynamics of IAV through exhibition swine is critical to mitigating the high incidence of variant IAV cases reported in association with agricultural fairs. We used genomic sequences from our exhibition swine surveillance to characterize the hemagglutinin and full genotypic diversity of IAV at early season shows and the subsequent dissemination through later season agricultural fairs. We were able to identify a critical time point with large implications for downstream IAV and zoonotic transmission. With improved understanding of evolutionary origins of zoonotic IAV, we can inform public health mitigation strategies to ultimately reduce zoonotic IAV transmission and risk of pandemic IAV emergence. |
Decision making and implementation of the first public sector introduction of typhoid conjugate vaccine - Navi Mumbai, India, 2018
Date K , Shimpi R , Luby S , N R , Haldar P , Katkar A , Wannemuehler K , Mogasale V , Pallas S , Song D , Kunwar A , Loharikar A , Yewale V , Ahmed D , Horng L , Wilhelm E , Bahl S , Harvey P , Dutta S , Bhatnagar P . Clin Infect Dis 2020 71 S172-s178 BACKGROUND: Typhoid fever prevention and control efforts are critical in an era of rising antimicrobial resistance among typhoid pathogens. India remains one of the highest typhoid disease burden countries, although a highly efficacious typhoid conjugate vaccine (TCV), prequalified by the World Health Organization in 2017, has been available since 2013. In 2018, the Navi Mumbai Municipal Corporation (NMMC) introduced TCV into its immunization program, targeting children aged 9 months to 14 years in 11 of 22 areas (Phase 1 campaign). We describe the decision making, implementation, and delivery costing to inform TCV use in other settings. METHODS: We collected information on the decision making and campaign implementation in addition to administrative coverage from NMMC and partners. We then used a microcosting approach from the local government (NMMC) perspective, using a new Microsoft Excel-based tool to estimate the financial and economic vaccination campaign costs. RESULTS: The planning and implementation of the campaign were led by NMMC with support from multiple partners. A fixed-post campaign was conducted during weekends and public holidays in July-August 2018 which achieved an administrative vaccination coverage of 71% (ranging from 46% in high-income to 92% in low-income areas). Not including vaccine and vaccination supplies, the average financial cost and economic cost per dose of TCV delivery were $0.45 and $1.42, respectively. CONCLUSION: The first public sector TCV campaign was successfully implemented by NMMC, with high administrative coverage in slums and low-income areas. Delivery cost estimates provide important inputs to evaluate the cost-effectiveness and affordability of TCV vaccination through public sector preventive campaigns. |
Fusing imperfect experimental data for risk assessment of musculoskeletal disorders in construction using canonical polyadic decomposition
Dutta A , Breloff SP , Dai F , Sinsel EW , Carey RE , Warren CM , Wu JZ . Autom Constr 2020 119 Field or laboratory data collected for work-related musculoskeletal disorder (WMSD) risk assessment in construction often becomes unreliable as a large amount of data go missing due to technology-induced errors, instrument failures or sometimes at random. Missing data can adversely affect the assessment conclusions. This study proposes a method that applies Canonical Polyadic Decomposition (CPD) tensor decomposition to fuse multiple sparse risk-related datasets and fill in missing data by leveraging the correlation among multiple risk indicators within those datasets. Two knee WMSD risk-related datasets—3D knee rotation (kinematics) and electromyography (EMG) of five knee postural muscles—collected from previous studies were used for the validation and demonstration of the proposed method. The analysis results revealed that for a large portion of missing values (40%), the proposed method can generate a fused dataset that provides reliable risk assessment results highly consistent (70%–87%) with those obtained from the original experimental datasets. This signified the usefulness of the proposed method for use in WMSD risk assessment studies when data collection is affected by a significant amount of missing data, which will facilitate reliable assessment of WMSD risks among construction workers. In the future, findings of this study will be implemented to explore whether, and to what extent, the fused dataset outperforms the datasets with missing values by comparing consistencies of the risk assessment results obtained from these datasets for further investigation of the fusion performance. |
Public health surveillance during Simhastha Kumbh, a religious mass gathering in Ujjain district, Madhya Pradesh, India, 2016
Goel P , Dhuria M , Yadav R , Khasnobis P , Meena S , Venkatesh S . Indian J Public Health 2020 64 (2) 198-200 A daily surveillance for disease detection and response at the Simhastha Kumbh Mela, in Ujjain, Madhya Pradesh, April-May 2016, was established. Existing weekly reporting of the Integrated Disease Surveillance Programme (IDSP) was modified to report 17 diseases or events from 22 public hospitals and three private hospitals in Ujjain. Water samples were also tested for fecal contamination in areas reporting diarrhea. We identified 56,600 ill persons (92% from government hospitals and 8% from private hospitals): 33% had fever, 28% acute respiratory infection, and 26% acute diarrheal diseases. There were 15 deaths (12 injury and 3 drowning). We detected two diarrhea outbreaks (Mahakaal Zone with 9 cases and Dutta Akhara Zone with 42 cases). Among 26 water samples, eight showed fecal contamination. This was a large implementation of daily disease surveillance in a religious mass gathering in India by IDSP. We recommended laboratory confirmation for diseases and similar daily surveillance in future mass gatherings in India. |
Effects of working posture and roof slope on activation of lower limb muscles during shingle installation
Dutta A , Breloff SP , Dai F , Sinsel EW , Warren CM , Carey RE , Wu JZ . Ergonomics 2020 63 (9) 1-17 Awkward and extreme kneeling during roofing generates high muscular tension which can lead to knee musculoskeletal disorders (MSDs) among roofers. However, the combined impact of roof slope and kneeling posture on the activation of the knee postural muscles and their association to potential knee MSD risks among roofers have not been studied. The current study evaluated the effects of kneeling posture and roof slope on the activation of major knee postural muscles during shingle installation via a laboratory assessment. Maximum normalized electromyography (EMG) data were collected from knee flexor and extensor muscles of seven subjects, who mimicked the shingle installation process on a slope-configurable wooden platform. The results revealed a significant increase in knee muscle activation during simulated shingle installation on sloped rooftops. Given the fact that increased muscle activation of knee postural muscles has been associated with knee MSDs, roof slope and awkward kneeling posture can be considered as potential knee MSD risk factors.Practitioner Summary: This study demonstrated significant effects of roof slope and kneeling posture on the peak activation of knee postural muscles. The findings of this study suggested that residential roofers could be exposed to a greater risk of developing knee MSDs with the increase of roof slope during shingle installation due to increased muscle loading. |
Kneeling trunk kinematics during simulated sloped roof shingle installation
Breloff SP , Carey RE , Dutta A , Sinsel EW , Warren CM , Dai F , Wu JZ . Int J Ind Ergon 2020 77 Trunk musculoskeletal disorders are common among residential roofers. Addressing this problem requires a better understanding of the movements required to complete working tasks, such as affixing shingles on a sloped residential roof. We analyzed the extent to which the trunk kinematics during a shingling process are altered due to different angles of roof slope. Eight male subjects completed a kneeling shingle installation process on three differently sloped roof surfaces. The magnitude of the trunk kinematics was significantly influenced by both slope and task phase of the shingling process, depending on the metric. The results unequivocally point to roof slope and task phase as significant factors altering trunk kinematics. However, extension of the results to roofing workers should be done carefully, depending on the degree to which the study protocol represents the natural setting. Future studies on shingle installation in residential roofing should absolutely consider capturing a wider array of shingling procedures in order to encapsulate all the possible methods that are used due to the lack of a standardized procedure. |
Identifying potentially risky phases leading to knee musculoskeletal disorders during shingle installation operations
Dutta A , Breloff SP , Dai F , Sinsel EW , Warren CM , Wu JZ . J Constr Eng Manage 2020 146 (3) Repeated and prolonged awkward kneeling can result in musculoskeletal disorders (MSD) in construction roofers. However, a task-specific risk assessment for roofers' knee injuries is still missing in the literature. This study identified a ranking-based ergonomic method for suggesting potentially risky phases that may increase knee MSD risk during shingle installation operations. On a slope-adjustable wooden platform in a laboratory setting, nine subjects performed shingle installations that included seven phases: (1) reaching for shingles, (2) placing shingles, (3) grabbing nail gun, (4) moving to first nailing position, (5) nailing shingles, (6) replacing nail gun, and (7) returning to upright position. Flexion, abduction, adduction, and internal and external knee rotations were measured to assess relative risks of these phases by ranking them with a scoring model. The ranking results revealed that the phases of placing shingles and nailing shingles lead to the most knee MSD risk exposure, and awkward flexion, abduction, and adduction involved in these phases can significantly contribute to the potential knee MSD risk measurement. By using the ranking-based method, this study suggested that certain phases of the shingle installation process may increase knee MSD risk, which is useful for developing effective interventions to reduce knee injury risk exposures from roof shingle installation. |
Are knee savers and knee pads a viable intervention to reduce lower extremity musculoskeletal disorder risk in residential roofers
Breloff SP , Sinsel EW , Dutta A , Carey RE , Warren CM , Dai F , Ning S , Wu JZ . Int J Ind Ergon 2019 74 One factor commonly associated with musculoskeletal disorder risk is extreme postures. To lessen this risk, extreme postures should be reduced using proactive and prevention-focused methods. The effect of combinations of two interventions, knee pads and knee savers, on lower extremity kinematics during deep or near full flexion kneeling on differently sloped surfaces was analyzed. Nine male subjects were requested to keep a typical resting posture while kneeling on a sloped roofing simulator with and without knee pads and knee savers. Three-dimensional peak knee kinematics were recording using a motion capture system. The kinematic data were analyzed with a two-way—4(intervention) X 3(slope)—repeated measure analysis of variance (ANOVA). It was observed that knee pads did not alter lower extremity kinematics in a way that may reduce musculoskeletal injury risk, but they do provide comfort. Knee savers did statistically significantly reduce peak lower extremity kinematics, however these changes were small and it is uncertain if the changes will reduce musculoskeletal injury risk. This study has provided initial data that supports the use of knee savers as a potential intervention to reduce musculoskeletal disorder risk due to lower extremity joint angles on a sloped surface, nonetheless, further testing involving other musculoskeletal disorder risk factors is needed prior to a conclusive recommendation. |
Oligodendrocyte involvement in Gulf War Illness
Belgrad J , Dutta DJ , Bromley-Coolidge S , Kelly KA , Michalovicz LT , Sullivan KA , O'Callaghan JP , Fields RD . Glia 2019 67 (11) 2107-2124 Low level sarin nerve gas and other anti-cholinesterase agents have been implicated in Gulf War illness (GWI), a chronic multi-symptom disorder characterized by cognitive, pain and fatigue symptoms that continues to afflict roughly 32% of veterans from the 1990-1991 Gulf War. How disrupting cholinergic synaptic transmission could produce chronic illness is unclear, but recent research indicates that acetylcholine also mediates communication between axons and oligodendrocytes. Here we investigated the hypothesis that oligodendrocyte development is disrupted by Gulf War agents, by experiments using the sarin-surrogate acetylcholinesterase inhibitor, diisopropyl fluorophosphate (DFP). The effects of corticosterone, which is used in some GWI animal models, were also investigated. The data show that DFP decreased both the number of mature and dividing oligodendrocytes in the rat prefrontal cortex (PFC), but differences were found between PFC and corpus callosum. The differences seen between the PFC and corpus callosum likely reflect the higher percentage of proliferating oligodendroglia in the adult PFC. In cell culture, DFP also decreased oligodendrocyte survival through a non-cholinergic mechanism. Corticosterone promoted maturation of oligodendrocytes, and when used in combination with DFP it had protective effects by increasing the pool of mature oligodendrocytes and decreasing proliferation. Cell culture studies indicate direct effects of both DFP and corticosterone on OPCs, and by comparison with in vivo results, we conclude that in addition to direct effects, systemic effects and interruption of neuron-glia interactions contribute to the detrimental effects of GW agents on oligodendrocytes. Our results demonstrate that oligodendrocytes are an important component of the pathophysiology of GWI. |
Assessing work-related risk factors for musculoskeletal knee disorders in construction roofing tasks
Breloff SP , Dutta A , Dai F , Sinsel EW , Warren CM , Ning X , Wu JZ . Appl Ergon 2019 81 102901 Roofers often suffer from musculoskeletal disorders (MSDs) to their knees due to spending a large amount of time kneeling while performing work-related roofing activities on sloped rooftops. Several ergonomic studies have identified kneeling as a potential risk factor for knee injuries and disorders. Existing biomechanical models and sensor technologies used to assess work-related risk factors for different construction trades are not applicable in roof work settings especially on slanted rooftop surfaces. This work assesses the impacts of work-related factors, namely working posture and roof slope, on the potential risk of developing knee MSDs due to residential roofing tasks in a laboratory setting. Nine human subjects participated in the experiment and mimicked shingle installation on a slope-configurable wooden platform. Maximum angles of right and left knee flexion, abduction, adduction, and axial rotation (internal and external) were measured as risk indicators using a motion capture system under different roof slope settings. The results demonstrated that roof slope, working posture and their interaction may have significant impacts on developing knee MSDs during roofing activities. Knees are likely to be exposed to increased risk of MSDs due to working in a dynamic kneeling posture during shingle installation. In our study, flexion in both knees and adduction in the right knee were found lower in high-pitched rooftops; however, abduction in the left knee and internal rotation in the right knee were found higher during shingle installation. Hence proper attention is needed for these situations. This study provides useful information about the impact of roof work settings on knee MSDs development, which may facilitate effective interventions such as education, training, and tools to prevent knee injuries in construction roofing tasks. |
Developing a model to predict unfavourable treatment outcomes in patients with tuberculosis and human immunodeficiency virus co-infection in Delhi, India
Madan C , Chopra KK , Satyanarayana S , Surie D , Chadha V , Sachdeva KS , Khanna A , Deshmukh R , Dutta L , Namdeo A , Shukla A , Sagili K , Chauhan LS . PLoS One 2018 13 (10) e0204982 BACKGROUND: Tuberculosis (TB) patients with human immunodeficiency virus (HIV) co-infection have worse TB treatment outcomes compared to patients with TB alone. The distribution of unfavourable treatment outcomes differs by socio-demographic and clinical characteristics, allowing for early identification of patients at risk. OBJECTIVE: To develop a statistical model that can provide individual probabilities of unfavourable outcomes based on demographic and clinical characteristics of TB-HIV co-infected patients. METHODOLOGY: We used data from all TB patients with known HIV-positive test results (aged >/=15 years) registered for first-line anti-TB treatment (ATT) in 2015 under the Revised National TB Control Programme (RNTCP) in Delhi, India. We included variables on demographics and pre-treatment clinical characteristics routinely recorded and reported to RNTCP and the National AIDS Control Organization. Binomial logistic regression was used to develop a statistical model to estimate probabilities of unfavourable TB treatment outcomes (i.e., death, loss to follow-up, treatment failure, transfer out of program, and a switch to drug-resistant regimen). RESULTS: Of 55,260 TB patients registered for ATT in 2015 in Delhi, 928 (2%) had known HIV-positive test results. Of these, 816 (88%) had drug-sensitive TB and were >/=15 years. Among 816 TB-HIV patients included, 157 (19%) had unfavourable TB treatment outcomes. We developed a model for predicting unfavourable outcomes using age, sex, disease classification (pulmonary versus extra-pulmonary), TB treatment category (new or previously treated case), sputum smear grade, known HIV status at TB diagnosis, antiretroviral treatment at TB diagnosis, and CD4 cell count at ATT initiation. The chi-square p-value for model calibration assessed using the Hosmer-Lemeshow test was 0.15. The model discrimination, measured as the area under the receiver operator characteristic (ROC) curve, was 0.78. CONCLUSION: The model had good internal validity, but should be validated with an independent cohort of TB-HIV co-infected patients to assess its performance before clinical or programmatic use. |
Statistical adjustment of culture-independent diagnostic tests for trend analysis in the Foodborne Diseases Active Surveillance Network (FoodNet), USA.
Gu W , Dutta V , Patrick M , Bruce BB , Geissler A , Huang J , Fitzgerald C , Henao O . Int J Epidemiol 2018 47 (5) 1613-1622 Background: Culture-independent diagnostic tests (CIDTs) are increasingly used to diagnose Campylobacter infection in the Foodborne Diseases Active Surveillance Network (FoodNet). Because CIDTs have different performance characteristics compared with culture, which has been used historically and is still used to diagnose campylobacteriosis, adjustment of cases diagnosed by CIDT is needed to compare with culture-confirmed cases for monitoring incidence trends. Methods: We identified the necessary parameters for CIDT adjustment using culture as the gold standard, and derived formulas to calculate positive predictive values (PPVs). We conducted a literature review and meta-analysis to examine the variability in CIDT performance and Campylobacter prevalence applicable to FoodNet sites. We then developed a Monte Carlo method to estimate test-type and site-specific PPVs with their associated uncertainties. Results: The uncertainty in our estimated PPVs was largely derived from uncertainty about the specificity of CIDTs and low prevalence of Campylobacter in tested samples. Stable CIDT-adjusted incidences of Campylobacter cases from 2012 to 2015 were observed compared with a decline in culture-confirmed incidence. Conclusions: We highlight the lack of data on the total numbers of tested samples as one of main limitations for CIDT adjustment. Our results demonstrate the importance of adjusting CIDTs for understanding trends in Campylobacter incidence in FoodNet. |
Multiple comparisons analysis of serological data from an area of low Plasmodium falciparum transmission
Rogier E , Wiegand R , Moss D , Priest J , Angov E , Dutta S , Journel I , Jean SE , Mace K , Chang M , Lemoine JF , Udhayakumar V , Barnwell JW . Malar J 2015 14 (1) 436 BACKGROUND: As a nation reduces the burden of falciparum malaria, identifying areas of transmission becomes increasingly difficult. Over the past decade, the field of utilizing malaria serological assays to measure exposure has grown rapidly, and a variety of serological methods for data acquisition and analysis of human IgG against falciparum antigens are available. Here, different immunoassays and statistical methods are utilized to analyse samples from a low transmission setting and directly compare the estimates generated. METHODS: A subset of samples (n = 580) from a 2012 Haitian nationwide malaria survey was employed as sample population of low falciparum endemicity. In addition to the Haitian samples, samples from 247 US residents were used as a reference population of 'true seronegatives'. Data acquisition was performed through standard ELISA and bead-based multiplex assays assaying for IgG antibodies to the Plasmodium falciparum antigens MSP-1p19, MSP-1p42(D), MSP-1p42(F), and AMA-1. Appropriate parametric distributions and seropositivity cutoff values were determined by statistical measures. RESULTS: Data from both assays showed a strong positive skew, and the lognormal distribution was found to be an appropriate statistical fit to the Haitian and American populations. The American samples served as a good serological true negative population for the multiplex assay, but not for ELISA-based data. Mixture model approaches to determine seronegative and seropositive populations from the Haitian data showed a high degree of distribution overlap-likely due to the historical low falciparum transmission in this nation. Different fittings to the reversible catalytic model resulted depending upon the immunoassay utilized and seropositivity cutoff method employed. Data were also analysed through fitting to penalized B-splines, presenting another possible analytical tool for the analysis of malaria serological data. CONCLUSIONS: Standardization of serological techniques and analyses may prove difficult as some tools can prove to be more useful depending on the area and parasite in question, making clear interpretation a vital pursuit. The presented analysis in the low-endemic nation of Haiti found malaria-naive US residents to be an appropriate seronegative reference population for the multiplex assay, and this assay providing consistent estimates between MSP-1 and AMA-1 antigens of percent seropositives for this low-endemic population. |
Phylogeographical analysis of the dominant multidrug-resistant H58 clade of Salmonella Typhi identifies inter- and intracontinental transmission events.
Wong VK , Baker S , Pickard DJ , Parkhill J , Page AJ , Feasey NA , Kingsley RA , Thomson NR , Keane JA , Weill FX , Edwards DJ , Hawkey J , Harris SR , Mather AE , Cain AK , Hadfield J , Hart PJ , Thieu NT , Klemm EJ , Glinos DA , Breiman RF , Watson CH , Kariuki S , Gordon MA , Heyderman RS , Okoro C , Jacobs J , Lunguya O , Edmunds WJ , Msefula C , Chabalgoity JA , Kama M , Jenkins K , Dutta S , Marks F , Campos J , Thompson C , Obaro S , MacLennan CA , Dolecek C , Keddy KH , Smith AM , Parry CM , Karkey A , Mulholland EK , Campbell JI , Dongol S , Basnyat B , Dufour M , Bandaranayake D , Naseri TT , Singh SP , Hatta M , Newton P , Onsare RS , Isaia L , Dance D , Davong V , Thwaites G , Wijedoru L , Crump JA , De Pinna E , Nair S , Nilles EJ , Thanh DP , Turner P , Soeng S , Valcanis M , Powling J , Dimovski K , Hogg G , Farrar J , Holt KE , Dougan G . Nat Genet 2015 47 (6) 632-9 The emergence of multidrug-resistant (MDR) typhoid is a major global health threat affecting many countries where the disease is endemic. Here whole-genome sequence analysis of 1,832 Salmonella enterica serovar Typhi (S. Typhi) identifies a single dominant MDR lineage, H58, that has emerged and spread throughout Asia and Africa over the last 30 years. Our analysis identifies numerous transmissions of H58, including multiple transfers from Asia to Africa and an ongoing, unrecognized MDR epidemic within Africa itself. Notably, our analysis indicates that H58 lineages are displacing antibiotic-sensitive isolates, transforming the global population structure of this pathogen. H58 isolates can harbor a complex MDR element residing either on transmissible IncHI1 plasmids or within multiple chromosomal integration sites. We also identify new mutations that define the H58 lineage. This phylogeographical analysis provides a framework to facilitate global management of MDR typhoid and is applicable to similar MDR lineages emerging in other bacterial species. |
Genetic variation in the Plasmodium falciparum circumsporozoite protein in India and its relevance to RTS,S malaria vaccine.
Zeeshan M , Alam MT , Vinayak S , Bora H , Tyagi RK , Alam MS , Choudhary V , Mittra P , Lumb V , Bharti PK , Udhayakumar V , Singh N , Jain V , Singh PP , Sharma YD . PLoS One 2012 7 (8) e43430 RTS,S is the most advanced malaria vaccine candidate, currently under phase-III clinical trials in Africa. This Plasmodium falciparum vaccine contains part of the central repeat region and the complete C-terminal T cell epitope region (Th2R and Th3R) of the circumsporozoite protein (CSP). Since naturally occurring polymorphisms at the vaccine candidate loci are critical determinants of the protective efficacy of the vaccines, it is imperative to investigate these polymorphisms in field isolates. In this study we have investigated the genetic diversity at the central repeat, C-terminal T cell epitope (Th2R and Th3R) and N-terminal T cell epitope regions of the CSP, in P. falciparum isolates from Madhya Pradesh state of India. These isolates were collected through a 5-year prospective study aimed to develop a well-characterized field-site for the future evaluation of malaria vaccine in India. Our results revealed that the central repeat (63 haplotypes, n = 161) and C-terminal Th2R/Th3R epitope (24 haplotypes, n = 179) regions were highly polymorphic, whereas N-terminal non-repeat region was less polymorphic (5 haplotypes, n = 161) in this population. We did not find any evidence of the role of positive natural selection in maintaining the genetic diversity at the Th2R/Th3R regions of CSP. Comparative analysis of the Th2R/Th3R sequences from this study to the global isolates (n = 1160) retrieved from the GenBank database revealed two important points. First, the majority of the sequences ( approximately 61%, n = 179) from this study were identical to the Dd2/Indochina type, which is also the predominant Th2R/Th3R haplotype in Asia ( approximately 59%, n = 974). Second, the Th2R/Th3R sequences in Asia, South America and Africa are geographically distinct with little allele sharing between continents. In conclusion, this study provides an insight on the existing polymorphisms in the CSP in a parasite population from India that could potentially influence the efficacy of RTS,S vaccine in this region. |
Perceived impact of the Medicare policy to adjust payment for health care-associated infections
Lee GM , Hartmann CW , Graham D , Kassler W , Dutta Linn M , Krein S , Saint S , Goldmann DA , Fridkin S , Horan T , Jernigan J , Jha A . Am J Infect Control 2012 40 (4) 314-9 BACKGROUND: In 2008, the Centers for Medicare and Medicaid Services (CMS) ceased additional payment for hospitalizations resulting in complications deemed preventable, including several health care-associated infections. We sought to understand the impact of the CMS payment policy on infection prevention efforts. METHODS: A national survey of infection preventionists from a random sample of US hospitals was conducted in December 2010. RESULTS: Eighty-one percent reported increased attention to HAIs targeted by the CMS policy, whereas one-third reported spending less time on nontargeted HAIs. Only 15% reported increased funding for infection control as a result of the CMS policy, whereas most reported stable (77%) funding. Respondents reported faster removal of urinary (71%) and central venous (50%) catheters as a result of the CMS policy, whereas routine urine and blood cultures on admission occurred infrequently (27% and 13%, respectively). Resource shifting (ie, less time spent on nontargeted HAIs) occurred more commonly in large hospitals (odds ratio, 2.3; 95% confidence interval: 1.0-5.1; P = .038) but less often in hospitals where front-line staff were receptive to changes in clinical processes (odds ratio, 0.5; 95% confidence interval: 0.3-0.8; P = .005). CONCLUSION: Infection preventionists reported greater hospital attention to preventing targeted HAIs as a result of the CMS nonpayment policy. Whether the increased focus and greater engagement in HAI prevention practices has led to better patient outcomes is unclear. |
Surveillance for malaria elimination in Swaziland: a national cross-sectional study using pooled PCR and serology
Hsiang MS , Hwang J , Kunene S , Drakeley C , Kandula D , Novotny J , Parizo J , Jensen T , Tong M , Kemere J , Dlamini S , Moonen B , Angov E , Dutta S , Ockenhouse C , Dorsey G , Greenhouse B . PLoS One 2012 7 (1) e29550 BACKGROUND: To guide malaria elimination efforts in Swaziland and other countries, accurate assessments of transmission are critical. Pooled-PCR has potential to efficiently improve sensitivity to detect infections; serology may clarify temporal and spatial trends in exposure. METHODOLOGY/PRINCIPAL FINDINGS: Using a stratified two-stage cluster, cross-sectional design, subjects were recruited from the malaria endemic region of Swaziland. Blood was collected for rapid diagnostic testing (RDT), pooled PCR, and ELISA detecting antibodies to Plasmodium falciparum surface antigens. Of 4330 participants tested, three were RDT-positive yet false positives by PCR. Pooled PCR led to the identification of one P. falciparum and one P. malariae infection among RDT-negative participants. The P. falciparum-infected participant reported recent travel to Mozambique. Compared to performing individual testing on thousands of samples, PCR pooling reduced labor and consumable costs by 95.5%. Seropositivity was associated with age ≥20 years (11.7% vs 1.9%, P<0.001), recent travel to Mozambique (OR 4.4 [95% CI 1.0-19.0]) and residence in southeast Swaziland (RR 3.78, P<0.001). CONCLUSIONS: The prevalence of malaria infection and recent exposure in Swaziland are extremely low, suggesting elimination is feasible. Future efforts should address imported malaria and target remaining foci of transmission. Pooled PCR and ELISA are valuable surveillance tools for guiding elimination efforts. |
Financial barriers to the adoption of combination vaccines by pediatricians
Gidengil CA , Dutta-Linn MM , Messonnier ML , Rusinak D , Lieu TA . Arch Pediatr Adolesc Med 2010 164 (12) 1138-44 OBJECTIVES: To describe the prevalence of combination vaccine use and the associated financial barriers faced by pediatric practices, and to identify determinants of adoption of combination vaccines. DESIGN: Mailed national survey. SETTING: Pediatric practices during the period from August through October 2008. PARTICIPANTS: Pediatricians randomly selected from the American Medical Association Masterfile. MAIN OUTCOME MEASURE: Use of 1 of 2 infant combination vaccines (the diphtheria and tetanus toxoids and acellular pertussis, hepatitis B virus, and inactivated poliovirus [DTaP-HepB-IPV] vaccine or the DTaP, IPV, and Haemophilus influenzae type b [DTaP-IPV/Hib] vaccine). RESULTS: We received 629 responses (response rate, 67%). Four hundred ninety-two pediatricians (78%) reported using 1 or both of the infant combination vaccines of interest (ie, the DTaP-HepB-IPV or DTaP-IPV/Hib vaccine). More than half of the respondents said their practice did not receive adequate reimbursement for the purchase and administration of vaccines in general. More than one-fifth reported not using 1 or more of the combination vaccines because of inadequate reimbursement for the cost of vaccine doses (23% of respondents) and/or vaccine administration (20% of respondents). The infant combination vaccines studied were less likely to be used by smaller practices, by those with a lower proportion of publicly insured patients, and by those with less inclusive state vaccine financing policies. CONCLUSIONS: One in 5 pediatricians reported that inadequate reimbursement prevented their using 1 or more combination vaccines. Practice size as well as the proportion of children whose vaccinations are paid for by public funds appear to be important determinants of the adoption of combination vaccines. |
Surveillance and molecular characterization of rotavirus strains circulating in Manipur, north-eastern India: increasing prevalence of emerging G12 strains
Mukherjee A , Chattopadhyay S , Bagchi P , Dutta D , Singh NB , Arora R , Parashar UD , Gentsch JR , Chawla-Sarkar M . Infect Genet Evol 2010 10 (2) 311-20 To determine the frequency and genotypes of rotavirus strains, samples were collected from children hospitalized with acute diarrhea at the Regional Institute of Medical Sciences, Manipur. The globally common genotypes G1P[8] and G2P[4] constituted 58% of the total positive strains, while 3% and 8% strains were emerging genotypes, G9P[6] and G12P[6]. This is the first report of genotype G12 in Manipur. The G12 strains clustered with lineage III strains and had >98% identity with corresponding rotaviruses from Bangladesh, Thailand and the USA. Other uncommon G-P combinations including G4P[4], G4P[6], G10P[6] and G9P[19], along with a few strains that could not be typed were also found. The VP7 genes of G4 and G10 strains clustered with porcine and bovine strains, indicating possible zoonotic transmission. High frequency (36-62%) of rotavirus infection and predominance of G1P[8] and G2P[4] among children with acute diarrhea emphasized the need for implementation of currently available vaccines to reduce the burden of rotavirus induced diarrhea in India. |
Accuracy of data on influenza vaccination status at four Vaccine Safety Datalink sites
Greene SK , Shi P , Dutta-Linn MM , Shoup JA , Hinrichsen VL , Ray P , Nordin JD , Kuckler L , Weintraub ES , Yih WK . Am J Prev Med 2009 37 (6) 552-5 BACKGROUND: Studies of influenza vaccination using electronic medical records rely on accurate classification of vaccination status. Vaccinations not entered into electronic records would be unavailable for study. PURPOSE: This study evaluated the sensitivity and negative predictive value (NPV) of electronic records for influenza vaccination and factors associated with failure to capture vaccinations. METHODS: In four diverse medical care organizations in the Vaccine Safety Datalink, those aged 50-79 years with no influenza vaccination record during the 2007-2008 season were surveyed by telephone, and electronic records were analyzed in 2008. The sensitivity and NPV of electronic records were estimated, using survey responses as the gold standard. Logistic regression models determined associations between 1-NPV and demographic factors, risk of influenza complications, and healthcare utilization levels. RESULTS: Data were obtained for 933 survey participants and 1,085,916 medical care organization members. Sites varied significantly in the sensitivity (51%, 68%, 79%, 89%) and NPV (46%, 62%, 66%, 87%) of electronic records. In multivariate analysis, the rate of failure to capture vaccinations was significantly higher for those aged 65-79 years than for those aged 50-64 years at three sites. Of vaccinations not captured by electronic records, 58% were reportedly administered in nontraditional settings, usually workplaces; the rest were given within the sites. CONCLUSIONS: Influenza vaccination studies relying on electronic records may misclassify substantial proportions of vaccinated individuals as unvaccinated, producing biased estimates of vaccine effectiveness. Sites with limited sensitivity to capture vaccinations administered within their organization should seek possible remedies. More complete capture of vaccinations administered to older patients and in nontraditional settings would further reduce misclassification. |
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